Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
NIHR Collaboration for Leadership in Applied Health Research and Care for Northwest London, London, UK.
Age Ageing. 2018 Mar 1;47(2):311-317. doi: 10.1093/ageing/afx194.
checklists are increasingly proposed as a means to enhance safety and quality of care. However, their use has been met with variable levels of success. The Frailsafe project focused on introducing a checklist with the aim to increase completion of key clinical assessments and to facilitate communication for the care of older patients in acute admissions.
to examine the use of the Frailsafe checklist, including potential to contribute to improved safety, quality and reliability of care.
110 qualitative interviews and group discussions with healthcare professionals and other specialties, 172 h of ethnographic observation in 12 UK hospitals and reporting of high-level process data (completion of checklist and relevant frailty assessments). Qualitative analysis followed a thematic and theory-driven approach.
through use of the checklist, hospital teams identified limitations in their existing assessments (e.g. absence of delirium protocols) and practices (e.g. unnecessary catheter use). This contributed to hospitals reporting just 24.0% of sampled patients as having received all clinical assessments across key domains for this population for the duration of the project (1,687/7,021 checklists as fully completed). Staff perceptions and experiences of using the checklist varied significantly, primarily driven by the extent to which the aims of this quality improvement project aligned with local service priorities and pre-existing team communications styles.
the Frailsafe checklist highlighted limitations with frailty assessment in acute care and motivated teams to review routine practices. Further work is needed to understand whether and how checklists can be embedded in complex, multidisciplinary care.
清单越来越多地被提议作为提高医疗保健安全性和质量的一种手段。然而，它们的使用取得了不同程度的成功。Frailsafe 项目专注于引入清单，旨在增加对关键临床评估的完成，并促进对急性入院的老年患者的护理沟通。
检查 Frailsafe 清单的使用情况，包括为提高护理的安全性、质量和可靠性做出贡献的潜力。
对医护人员和其他专业人员进行了 110 次定性访谈和小组讨论，在 12 家英国医院进行了 172 小时的民族志观察，并报告了高级流程数据（清单和相关脆弱性评估的完成情况）。定性分析采用了主题和理论驱动的方法。
通过使用清单，医院团队发现了现有评估（例如缺乏谵妄协议）和实践（例如不必要的导管使用）中的局限性。这促使医院报告在项目期间（7021 份清单中有 24.0%的患者完成了所有关键领域的所有临床评估），只有 24.0%的抽样患者接受了所有关键领域的临床评估。员工对使用清单的看法和经验差异很大，主要是由于这个质量改进项目的目标与当地服务重点和预先存在的团队沟通风格的吻合程度不同。
Frailsafe 清单突出了急性护理中脆弱性评估的局限性，并促使团队审查常规做法。需要进一步研究了解清单是否以及如何可以嵌入到复杂的多学科护理中。
